Citation Nr: 1322653 Decision Date: 07/16/13 Archive Date: 07/24/13 DOCKET NO. 06-38 520 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Des Moines, Iowa THE ISSUES 1. Entitlement to an initial compensable evaluation for bilateral otitis media. 2. Entitlement to an initial compensable evaluation for chronic allergic perennial rhinitis prior to January 23, 2013, and a rating higher than 10 percent thereafter. 3. Entitlement to an initial rating higher than 10 percent for a mood disorder. 4. Entitlement to an initial compensable evaluation for status post repair of the right long finger prior to January 23, 2013, and a rating higher than 10 percent thereafter. 5. Entitlement to an initial compensable evaluation for status post repair of the right little finger. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD D.J. Drucker, Counsel INTRODUCTION The Veteran had active military service from May 1978 to May 1982, from August 1982 to July 2000, and from June 2002 to June 2004. This matter initially came to the Board of Veterans' Appeals (Board) on appeal from June 2005, November 2006, and April 2008 rating decisions of the Department of Veterans Affairs (VA) in Des Moines, Iowa, and St. Paul, Minnesota. The June 2005 rating decision granted service connection for bilateral otitis media, chronic allergic perennial rhinitis, and status post repair of the right long and little fingers that were assigned initial noncompensable disability evaluations, effective from June 17, 2004. The November 2006 rating decision denied service connection for migraine headaches and the April 2008 rating decision granted service connection for a mood disorder that was assigned an initial 10 percent rating, effective from November 20, 2007. Jurisdiction of the Veteran's case is currently with the VA RO in Des Moines, Iowa. In July 2012, the Veteran testified at a hearing conducted via videoconference with the undersigned. A transcript of the hearing is of record. In a November 2012 decision, the Board granted service connection for migraines. At that time; the Board remanded the remaining issues to the RO via the Appeals Management Center (AMC) in Washington, D.C., for further development. In a February 2013 rating decision, the Appeals Management Center granted 10 percent ratings for allergic perennial rhinitis and status post repair of his right long finger, effective from January 23, 2013. In November 2012, the Board indicated that the Veteran raised a claim for entitlement to service connection for a neurologic disorder of the right forearm and referred the matter to the Agency of Original Jurisdiction (AOJ). There is no indication that the AOJ has yet considered this matter and it is, again, referred to the AOJ for appropriate action. FINDINGS OF FACT 1. The Veteran has had Level I hearing loss in both ears since the effective date of service connection for otitis media. 2. From June 17, 2004 to December 9, 2007, the Veteran's chronic allergic perennial rhinitis was not manifested by polyps, greater than 50 percent obstruction of nasal passages on both sides, or complete obstruction on one side, or by impairment approximating such a level of severity. 3. From December 10, 2007 to February 26, 2009, the Veteran's chronic allergic rhinitis was manifested by small nasal polyps on the left. 4. From February 27, 2009 to January 22, 2013, the Veteran's chronic allergic rhinitis was not manifested by polyps, greater than 50 percent obstruction of nasal passages on both sides, or complete obstruction on one side, or by impairment approximating such a level of severity. 5. Since January 23, 2013, the Veteran's chronic allergic rhinitis has been manifested by symptoms approximating greater than 50 percent obstruction of nasal passages on both sides without polyps. 6. Since the effective date of service connection, the Veteran's mood disorder has been manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks throughout the appeal period. It has not been productive of occupational and social impairment with reduced reliability and productivity. 9. Prior to January 23, 2013, residuals of a right long finger repair were manifested by subjective complaints of limited motion and decreased strength during cold weather with no objective evidence a gap of one inch or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. 10. Since January 23, 2013, there is no evidence of favorable or unfavorable ankylosis or any finding commensurate with amputation of the right long finger. 11. Residuals of the status post repair of the Veteran's right little finger are not productive of favorable or unfavorable ankylosis, or any finding commensurate with amputation. 12. The objective evidence of record is in equipoise as to whether residuals of the Veteran's right little finger disability are commensurate with mild ulnar nerve disablement. CONCLUSIONS OF LAW 1. The criteria for an initial compensable evaluation for bilateral otitis media are not met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 3.321, 4.85, 4.86, Diagnostic Code (DC) 6100, 6201 (2012). 2. From June 17, 2004 to December 9, 2007, the criteria for an initial compensable evaluation for chronic allergic perennial rhinitis were not met. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.97, DC 6522 (2012). 3. From December 10, 2007 to February 26, 2009, the criteria for a 30 percent evaluation for chronic allergic perennial rhinitis, but no higher, were met. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.97, DC 6522. 4. From February 27, 2009 to January 22, 2013, the criteria for a compensable evaluation for chronic allergic perennial rhinitis, were not met. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.7, 4.97, DC 6522. 5. Since January 23, 2013, the criteria for a rating in excess of 10 percent for chronic allergic perennial rhinitis, have not been met. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.7, 4.97, DC 6522. 6. Resolving doubt in the Veteran's favor, since November 20, 2007, the criteria for an initial 30 percent rating, but no higher, for a mood disorder, are met. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321, 4.130, DC 9435 (2012). 7. The criteria for an initial compensable evaluation for status post repair of the right long finger prior to January 23, 2013, and a rating higher than 10 percent thereafter, are not met. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321, 4.71a, DC 5229 (2012). 8. The criteria for an initial compensable evaluation for status post repair of the right little finger are not met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.71a, DC 5230 (2012). 9. The criteria for a separate 10 percent rating, but no higher, for right little finger ulnar nerve disablement have been met since June 17, 2004. 38 U.S.C.A. §§ 1155, 5103; 38 C.F.R. §§ 4.3, 4.7, 4.124a, DC 8516 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2013); 38 C.F.R §§ 3.102, 3.156(a), 3.159, 3.326(a). The claim arises from disagreement with the initial rating following the grant of service connection. The courts have held that once service connection is granted the claim is substantiated, additional VCAA notice is not required; and any defect in the notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). VA has done everything reasonably possible to assist the Veteran with respect to his claims for benefits in accordance with 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c). His service treatment and personnel records and VA and private records have been associated with the claims file, to the extent available. All reasonably identified and available medical records have been secured. A review of the Veteran's Virtual VA electronic file reveals VA medical records, added to the record in December 2011 and February 2012, and dated from October 2011 to February 2012, that were not considered by the Agency of Original Jurisdiction (AOJ) in the February 2013 supplemental statement of the case. But, in a June 2013 signed statement, the Veteran's service representative waived initial AOJ review of this new evidence. See 38 C.F.R. § 20.1304(c) (2012). In December 2004, September 2006, March 2008, August 2009, and July 2010, the Veteran underwent VA examinations and these examination reports are of record. In November 2012, the Board remanded the Veteran's case to the AOJ to afford him new VA examinations. There has been substantial compliance with this remand, as he underwent VA audiology, hand, ear, sinusitis/rhinitis, and psychological examinations in January 2013. The December 2004, September 2006, March 2008, August 2009, July 2010, and January 2013 VA examination reports are adequate for rating purposes as the claims file was reviewed, the examiners reviewed the pertinent history, examined the Veteran, provided clinical findings and diagnoses, and offered etiological opinions with rationales from which the Board can reach a fair determination. 38 C.F.R. § 3.326 (2012). The Board finds the duties to notify and assist have been met. The United States Court of Appeals for Veterans Claims has interpreted the provisions of 38 C.F.R. § 3.103(c)(2) (2013) as imposing two distinct duties on VA employees, including Board personnel, in conducting hearings: The duty to explain fully the issues and the duty to suggest the submission of evidence that may have been overlooked. Bryant v. Shinseki, 23 Vet. App. 488 (2010) (per curiam). At the Veteran's hearing the issues were identified, including the evidence needed to substantiate the appeals. There was a discussion of possible evidence that could substantiate the claims and testimony lead to the remand for new examinations. The Bryant duties were thereby met. II. Factual Background and Legal Analysis Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (2012). Each service-connected disability is rated on the basis of specific criteria identified by Diagnostic Codes. 38 C.F.R. § 4.27 (2012). In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). In Fenderson v. West, 12 Vet. App. 119, 126 (1999), the court noted that where the question for consideration is propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of a "staged rating" is required. Id. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21 (2012). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). The Veteran's statements describing the symptoms of his service-connected otitis media, rhinitis, mood disorder, and right finger disabilities are deemed competent. These statements are considered with the clinical evidence of record and in conjunction with the pertinent rating criteria. A. Bilateral Otitis Media The Veteran underwent VA general medical and ear disease examinations in December 2004. He complained of hearing difficulty and tinnitus and denied having vertigo, balance/gait problems, discharge, and pain. On examination, his mastoids were normal, and his auricles were without deformity or tissue loss. The Veteran's ear canals were clear without edema, scaling, or discharge. His tympanic membranes were intact, with old scarring, and inferior-anterior tympaosclerosis of both tympanic membranes. There was no middle or inner ear active disease or infection. On VA audiological evaluation in December 2004, pure tone thresholds, in decibels (dB.), were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 5 15 25 25 LEFT 10 5 15 25 40 The Veteran averaged a 20 dB. loss for the right ear and a 21 dB. loss for the left ear for the frequencies 1,000, 2,000, 3,000, and 4,000 Hertz (Hz.) His speech recognition score on the Maryland CNC Word List was 98 percent in the right ear and 96 percent in the left ear. VA medical records show that, on March 15, 2006, the Veteran was seen in the outpatient clinic with complaints of an ear ache for the past two weeks. There was fluid noted behind his left tympanic membrane. On December 7, 2006, he complained of his ears popping for the past 12 months. On examination, the Veteran's tympanic membranes were normal on the right and heavily scarred on the left with few small perforations and no redness or discharge. In January 2007, the Veteran was seen in the VA outpatient clinic and requested evaluation for hearing aids. He complained of decreased speech recognition ability, worse in the presence of ambient noise. On VA clinical audiological evaluation in January 2007, pure tone thresholds, in dB., were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 10 20 20 35 LEFT 15 5 15 25 40 The Veteran averaged a 21 dB. loss for the right ear and a 21 dB. loss for the left ear for the frequencies 1,000, 2,000, 3,000, and 4,000 Hz. His speech recognition score on the Maryland CNC Word List was 96 percent in the right ear and 92 percent in the left ear. In February 2007, the Veteran was fitted for hearing aids in the VA clinic. An audiologist noted that he was a marginal hearing aid candidate. The Veteran underwent VA examination in July 2010. He reported an occasional sensation of losing his balance and dizziness and denied any discharge from his ears. He had ear pain three to four times a month for three to four days. His ears itched with lots of dry scaly material coming from them. He had occasional ear pain. The Veteran worked as a letter carrier for the United States Postal Service. On examination, the Veteran's auricles were without deformity or tissue loss. His ear canals were clear without edema, scaling, or discharge. The tympanic membranes were normal. There was no active ear disease, and no infectious disease of the middle or inner ears. Otitis media was not found on examination. On VA audiological evaluation in July 2010, pure tone thresholds, in dB., were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 10 20 30 40 LEFT 20 15 20 35 45 The Veteran averaged a 25 dB. loss for the right ear and a 29 dB. loss for the left ear for the frequencies 1,000, 2,000, 3,000, and 4,000 Hz. His speech recognition score on the Maryland CNC Word List was 94 percent in the right and left ears. In May 2011, the Veteran was seen in the VA outpatient clinic for evaluation for hearing aids. During his July 2012 Board hearing, the Veteran testified that he usually wore hearing aids, but with any background noise, he had difficulty understanding conversational speech. See Board hearing transcript at page 14. He also had difficulty hearing high pitched noises with or without his hearing aids. Id. at 15. He recently received new hearing aids that helped until one stopped working. Id. at 16. The Veteran had intermittent dizziness and loss of balance and believed he fell more than other colleagues who also delivered mail. Id. at 17. The Veteran underwent a VA examination for ear diseases in January 2013. It was noted that he was or had been diagnosed with a peripheral vestibular condition. He complained of pain in his ears approximately three to four times per month, for three to four days at a time, dry scaly effusion in his ears, and constant itching. The Veteran had bilateral otitis media twice every three months that resolved on its own and, if not, he sought medical treatment. He had congestion behind his ear pressure, ear popping, and drainage in the back of his throat. His tinnitus worsened and he had ear pain. The Veteran denied vertigo, but reported balance or gait problems two to three times a week, for one or two minutes that went away. He did not take prescribed medication for his ear condition. He had a dry and scaly external ear canal, itching, effusion, and hearing impairment and tinnitus with no vestibular conditions. Physical examination showed that the Veteran had a normal ear canal, with a perforated left tympanic membrane (with scarring and white discharge noted) and evidence of a healed perforation of the right tympanic membrane. His gait was steady. The diagnosis was chronic-non-exudative otitis media, worse in the left ear than the right. On VA audiological evaluation in January 2013, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 15 30 35 45 LEFT 15 10 25 40 65 The Veteran averaged a 31 dB. loss for the right ear and a 34 dB. loss for the left ear for the frequencies 1,000, 2,000, 3,000, and 4,000 Hz. His speech recognition score on the Maryland CNC Word List was 100 percent in the right and left ears. As to the functional impact of the Veteran's hearing loss, the VA audiologist noted that the Veteran reported problems with hearing his wife when the television was on. He also had problems hearing speech at distances and needed to pay close attention to what was said or he was unable to understand. The Veteran also had recurrent tinnitus that did not affect his daily life. Analysis The Veteran's bilateral otitis media is rated under Diagnostic Code 6201, which provides that chronic nonsuppurative otitis media with effusion (serous otitis media) is to be rated based on hearing impairment. 38 C.F.R. § 4.87, Diagnostic Code 6201. The criteria for evaluating audiological disabilities are found at 38 C.F.R. §§ 4.85-4.87. "Unusual patterns of hearing impairment", may be evaluated under 38 C.F.R. § 4.86. An "unusual patterns of hearing impairment" involves cases where the pure tone thresholds at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hz) is 55 decibels or more, or where the pure tone thresholds are 30 decibels or less at 1000 Hz and 70 decibels or more at 2000 Hz. The hearing examinations noted above show that the Veteran's bilateral hearing loss pattern has not fit the requirements of an unusual pattern of hearing impairment at any point during the course of his appeal. Evaluations of bilateral defective hearing range from noncompensable to 100 percent disabling, based upon organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests together with the average hearing threshold level as measured by pure tone audiometry testing in the frequencies 1000, 2000, 3000, and 4000 Hertz per second. The Rating Schedule establishes eleven different auditory acuity levels, designated from Level I for essentially normal auditory acuity to Level XI for profound deafness. 38 C.F.R. §§ 4.85-4 .87, Diagnostic Code 6100. The results of the audiometric testing described above when applied to the tables in 38 C.F.R. § 4.85 show that the Veteran has had Level I hearing in both ears throughout the period since the effective date of service connection. There is no evidence of record that describes audiometric testing that would warrant a compensable rating for bilateral hearing loss. The Veteran has reported additional symptoms, including intermittent balance problems, but these have not been attributed to the service connected otitis media and the rating schedule does not recognize those symptoms as elements of otitis media. Thus, the evidence is against a finding that the Veteran's service-connected bilateral otitis media meets the schedular criteria for an initial compensable rating. There is no evidence that the examinations conducted by VA are inadequate for rating purposes and the Veteran has not contended otherwise. The evidence is not so evenly balanced that there is doubt as to any material issue regarding the matter of an increased (compensable) initial rating for the service-connected bilateral hearing loss. 38 U.S.C.A. § 5107(b). B. Chronic Allergic Perennial Rhinitis The Veteran's allergic rhinitis is evaluated under DC 6522 that addresses both allergic and vasomotor rhinitis. 38 C.F.R. § 4.97. Under DC 6522, a 10 percent evaluation is assigned when there are no polyps, but with greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. A 30 percent evaluation is assigned when there are polyps as well. Id. Facts The December 2004 VA general medical examination report shows that the Veteran complained of having a constant runny nose and post nasal drip since his return from Saudi Arabia. It was noted that, in 1992 he had a nasopharyngoscopy with removal of retained food foreign body but no polyps or other pathology was found. He never had x-rays or a magnetic resonance image (MRI). On examination, his nose was patent, bilaterally with midline septum, muscosa pink and moist, and sinuses nontender. His orophyarynx was clear and normal. The diagnoses included chronic allergic perennial rhinitis and negative clinical exam and laboratory tests that day. A September 2006 VA examination report indicates that the Veteran complained of nasal stuffiness that occurred four to five times a month and generally lasted for two or three days when he felt extremely congested. On examination, his nose was patent bilaterally, with pink, moist mucosa, nontender sinuses and an orophyarynx within normal limits. The assessment included chronic allergic perennial rhinitis with sinus headaches that caused mild functional impact. A December 7, 2006 VA primary care outpatient note includes the Veteran's complaints of a stuffy nose. On examination, there was mildly swollen mucosa, no redness, no polyps, and no discharge. The assessment included questionable rhinitis. When seen in the VA outpatient clinic on December 10, 2007, the Veteran complained of nasal congestion and had no yellow discharge. On examination of his nose, there was mildly swollen mucosa and redness, with small polyps on the left, but no discharge. The assessment included rhinitis/polyps. In April 2008, the VA medical records show that the Veteran was seen for cold-like symtoms, runny nose, congestion, and sinus drainage for the past two weeks. He had a yellow nasal discharge and was assessed with sinusitis and bronchitis. When the Veteran was seen the VA outpatient clinic on February 27, 2009, there were no polyps present. A September 2009 VA primary care outpatient record similarly reflects findings of normal mucosa, no polyps, and no discharge. An August 2009 VA examination report reflects that the Veteran had increased nasal discharge and rhinitis symtoms during the past six months. His primary care physician prescribed an inhaler two or three months earlier that helped his symtoms. On examination, there was no tenderness, erythema, or swelling overlying his facial sinuses. The VA examiner commented that the Veteran's current complaints were related to allergic rhinitis as historically present. April 2010 VA medical records indicate that the Veteran complained of allergic rhinitis symtoms since service. His nose was patent, his septum was midline, his sinuses were nontender, and his pharynx was clear. The July 2010 VA examination report includes the Veteran's complaints of having a runny nose since service for which he had to carry tissues and tried various nose sprays, to no avail. Some days he felt congested and other days he just had a continuously runny nose. He complained of frequently having difficulty breathing through his nose. The Veteran denied having a purulent discharge but had a copious amount of clear drainage at times. His speech was occasionally impaired due to a post nasal drip irritating the vocal cords and posterior orophyarynx and he occasionally had to breathe through his mouth. The Veteran denied dyspnea and other symtoms, other than occasionally breathing through his mouth. He denied functional impact from his rhinitis other than the need to constantly keep tissues with him and was not incapacitated by the disorder. Examination revealed that his nose was patent, bilaterally, muscosa with slightly boggy turbinate but moist was noted, and sinuses were not tender. The Veteran's allergic perennial rhinitis was stable. February 2012 private medical records reveal that the Veteran was treated for sinusitis. On examination, his nasal mucosa had marked erythema and rhinorrhea. His orophyarynx was moist and there was no erythema or exudates. The assessment included sinusitis that was treated with antibiotics. During his July 2012 Board hearing, the Veteran said that he experienced nasal congestion in both nostrils, whether it was called sinusitis or rhinitis. See Board hearing transcript at page 10. He had sinus infections since military service and tests for allergies were negative. Id. The Veteran had attacks about once a month. Id. at 11. He said VA prescribed allergy medication that was not effective so he stopped taking it or going for VA treatment. Id. at 13-14. According to the January 23, 2013 VA examination report, the Veteran reported repeated treatment for sinusitis with antibiotics after which he felt better and the maxillary pain was gone. Nasal sprays were ineffective and, in spring 2012, he sought private medical treatment because he was congested, could not breathe and had drainage in the back of his throat that was treated with antibiotics. The Veteran had a purulent discharge that was dark yellow, no speech impairment, and dyspnea. The examiner noted that the Veteran had chronic maxillary sinusitis, with headaches, pain and tenderness of the affected sinus, and purulent discharge. The VA examiner reported that the Veteran had a greater than 50 percent obstruction of his nasal passage on both sides due to rhinitis with permanent hypertrophy of the nasal turbinates. Neither side was completely obstructed. There were no nasal polyps noted and no deviated septum. Further, the VA examiner indicated that the Veteran's sinus, nose, throat, larynx, or pharynx condition did not impact the Veteran's ability to work. The examiner commented that chronic sinusitis, allergic rhinitis, and otitis media were more likely than not inter-related health issues for the Veteran. Analysis In February 2013, the AMC granted service connection and a separate rating for chronic maxillary sinusitis. VA's Schedule for Rating Disabilities considers allergic rhinitis and sinusitis as separate disabilities for rating purposes. See 38 C.F.R. § 4.97, DC 6510-14 (sinusitis) and DC 6522 (allergic or vasomotor rhinitis) (2012). If co-existing, separate disability ratings may be assigned for both disorders. 38 C.F.R. § 4.96(a) (2012). As such, the Board will specifically limit this analysis to the matter of entitlement to higher initial ratings for service-connected allergic rhinitis that is in appellate status. Given the nature of the Veteran's disability; the rating criteria under DC 6522 used to evaluate allergic rhinitis are the most appropriate for evaluating the Veteran's disability. See Pernorio v. Derwinski, 2 Vet. App. 625 (1992); 38 C.F.R. §§ 4.20, 4.21 (2012). The evidence in this case clearly reflects that, for the period prior to December 10, 2007, polyps were not present and a greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side was not shown. When evaluated by VA in December 2004, there was no indication of polyps and examination revealed that the Veteran's nose was patent (i.e. open), bilaterally. Similar findings were reported by the September 2006 VA examiner. No other evidence dated prior to December 10, 2007 reveals the presence of either of the aforementioned manifestations required to support the assignment of a compensable 10 percent evaluation under DC 6522. Accordingly, for the period from June 17, 2004 to December 9, 2007, the criteria for an initial compensable evaluation for rhinitis were not met. The VA medical record, dated on December 10, 2007, contains findings consistent with a report of small polyps on the left, warranting the assignment of a 30 percent evaluation. But, when the Veteran was evaluated in the VA outpatient clinic on February 27, 2009, there was no clinical evidence of polyps. Thus, the criteria for the assignment of a 30 percent evaluation, based on evidence of allergic rhinitis with polyps, are met for the portion of the appeal period extending from December 10, 2007 to February 26, 2009 and, to this extent, the appeal is granted. For the period from February 27, 2009 to January 22, 2013, polyps were not present and a greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side was not shown, as reflected in the August 2009 and July 2010 VA examination reports and VA and non-VA medical records. Thus, for the period from February 27, 2009 to January 22, 2013, the criteria for a compensable evaluation for rhinitis were not met. For the period from January 23, 2013, the evidence shows that the Veteran had nasal airway obstruction of greater than 50 percent on both sides with permanent hypertrophy of the nasal turbinates but there was no evidence of polyps, as reflected in the January 23, 2013 VA examination report. Thus, from January 23, 2013, a rating in excess of the currently assigned 10 percent rating is not warranted under DC 6522 for the Veteran's chronic perennial allergic rhinitis. The Board has also considered whether any other diagnostic codes would allow for a higher disability rating for any period on appeal. DC 6523 addresses bacterial rhinitis, and provides for a 10 percent evaluation when there is permanent hypertrophy of the turbinates with greater than 50 percent obstruction of the nasal passages on both sides or complete obstruction on one side. 38 C.F.R. § 4.97, DC 6523 (2012). A 50 percent evaluation is assigned when there is rhinoscleroma. The January 2013 VA examiner reported permanent hypertrophy of the Veteran's nasal turbinates with greater than a 50 percent obstruction of the nasal passages on both sides, but there was no reported evidence of rhinoscleroma. Thus, the criteria for a 50 percent rating under DC 6523 are not met. Id. DC 6524 does not apply, as there is no evidence of granulomatosis or granulomatous infection at any point during the Veteran's appeal. 38 C.F.R. § 4.97, DC 6524 (2012). Moreover, there is no evidence of injury to or residuals of injuries to the larynx and pharynx, so DCs 6520 and 6521 do not apply. 38 C.F.R. § 4.97, DC 6520, 6521 (2012). Accordingly, from June 17, 2004 to December 9, 2007, the preponderance of the credible and objective evidence of record is against an initial compensable rating for the Veteran's service-connected chronic perennial allergic rhinitis and the benefit-of-the-doubt rule does not apply. 38 U.S.C.A. § 5107(b). However, resolving all doubt in the Veteran's favor, from December 10, 2007 to February 26, 2009, a 30 percent rating is warranted for his allergic rhinitis. The benefit of the doubt has been resolved in the Veteran's favor to this limited extent. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, supra. But, the preponderance of the objective and credible evidence of record is against a compensable rating for the Veteran's chronic allergic perennial rhinitis from February 27, 2009 to January 22, 2013, and against a rating in excess of 10 percent from January 23, 2013. Moreover, as the preponderance of the probative medical and other evidence of record is against the claim for an increased initial rating for rhinitis for these periods, the benefit-of-the-doubt rule does not apply. 38 U.S.C.A. § 5107(b). C. Mood Disorder The General Rating Formula for Mental Disorders, including Diagnostic Code 9435, that evaluates mood disorders provides the criteria for rating psychiatric disabilities. A 10 percent evaluation is provided for occupational and social impairment due to mild or transient symtoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress or, symtoms controlled by continuous medication. 38 C.F.R. § 4.130, Diagnostic Code 9435. A 30 percent evaluation is provided for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent rating is warranted if the disability is productive of occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. Global Assessment of Functioning (GAF) scores are a scale reflecting the "psychological, social and occupational functioning on a hypothetical continuum of mental health- illness." See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996) (citing the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM IV), page 32). A GAF score of 51 to 60 indicates the examiner's assessment of moderate symptoms (e.g., a flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). A GAF score of 61 to 70 denotes mild symptoms or some difficulty in social and occupational functioning. When it is not possible to separate the effects of a non- service-connected condition from those of a service-connected disorder, reasonable doubt should be resolved in the claimant's favor with regard to the question of whether certain signs and symptoms can be attributed to the service- connected disability. See Mittleider v. West, 11 Vet. App. 181, 182 (1998); see also 38 C.F.R. § 3.102; Mauerhan v. Principi, 16 Vet. App. 436 (2002) (factors listed in the rating formula are examples of conditions that warrant a particular rating and are used to help differentiate between the different evaluation levels.). Facts The Veteran underwent VA examination in March 2008. He denied receiving any treatment for a mental disorder or taking prescribed psychoactive medications. The Veteran was mainly concerned about his pain problems. The Veteran lived with his wife in their home and worked nearly full time as a substitute mail carrier for the local United States Post Office. He complained that pain interfered with his letter carrying work. The Veteran was not a member of any organizations but attended church and did minor repairs on the church. He ate meals out and saw family fairly often. He had sleep problems, and awoke several times a night primarily due to pain. The Veteran had irritability and some jumpiness, but denied suicidal ideation or crying spells. On examination, the Veteran did not appear to be in acute distress and showed some tendency to downplay symtoms. His speech was logical with no indication of hallucinations, delusions, or thought disorder. He was oriented, with adequate memory and concentration. There were no obsessions or compulsions. The diagnosis was a mood disorder due to general medical conditions. The Veteran met the criteria for a diagnosis of a mood disorder due to general medical conditions but, the examiner stated that the extent of impairment was "not very great." The Veteran appeared to be someone who, due to signs and symptoms of a mood disorder, would have impairment that was transient or mild, and decreased work efficiency and his ability to perform occupational tasks only during periods of significant stress. A GAF score of 62 was assigned. In an April 2008 Addendum, the VA examiner noted that the Veteran's mood disorder was "indicated as minor only." When seen by his VA primary care physician in June 2009, the Veteran expressed concern about memory issues. He felt his memory was not as sharp and he was slower than he should be at sorting mail. He forgot to deliver mail at homes and had to return. The Veteran was having sleep difficulty. The Veteran was referred for a psychological evaluation and his primary care physician felt that some of the cognition problem may be poor sleeping and depression, but the Veteran wanted to be evaluated. According to a July 6, 2009 VA outpatient psychological consult record, the Veteran was seen for an evaluation of problems with depression, and complaints of poor memory and forgetfulness. He was a postal worker and reported that he was slow and below benchmark standards for sorting mail prior to going out on his delivery route. The Veteran worked nearly fulltime and did well with the actual delivery aspect of his job but felt he was slow with the sorting aspect of it. He received supervisory feedback over the past two or three weeks showing that he was consistently slow with sorting duties. The Veteran felt he went at about the same rate he always did and supervisors were just now getting specific with time measurements. He did not feel that he was overly distracted or inattentive in sorting duties. The Veteran lived with his wife in their home and they had two adult children and a granddaughter. He had past marital problems and alluded to previous anger problems on his part that were no longer an issue. The Veteran reported a good relationship with his wife and felt stress was minimal in his life. On examination, the Veteran was alert and oriented. He showed no signs of obvious distraction or inattention during the interview. The Veteran denied feelings of depression, anxiety, and obsessive compulsive symtoms. He minimized anger problems, especially over the past year. The Veteran complained of infrequent nightmares. A GAF score of 58 was assigned. In July 2010, the Veteran underwent VA examination performed by the psychologist who evaluated him in March 2008. The Veteran denied receiving any counseling since his last VA examination other than the one meeting with a psychologist (in July 2009). According to the examiner, the Veteran down-played anxiety and depressive symtoms and seemed to minimize anger problems over the past year during his meeting with that psychologist. The Veteran currently complained that he thought he was more irritable and said he punched walls at his home. He seemed to indicate that he overreacted to small frustrations and that his wife was afraid of him. The Veteran denied hitting her but had grabbed her in the past. He continued to live with his wife in their home and worked parttime as a mail carrier but, due to a hiring freeze, worked longer hours. He occasionally lost focus and skipped some delivery spots so he had to backtrack to homes or mail boxes a second time. This happened several times a month. The Veteran attended church sometimes. He and his wife visited their daughter, her husband, and granddaughter in Arizona. The Veteran and his wife went to ball games for the wife's younger relatives and took motorcycle rides, sometimes with other couples, when they stopped for supper out in nearby towns. The Veteran had sleep difficulty, with occasional nightmares, was irritable and easily frustrated, and had some problems with anger control. He startled easily. Patriotic reminders caused him to be choked up but he denied crying spells and suicidal ideation. The Veteran had memory problems on occasion. He forgot to do things his wife asked and needed to write down tasks. He was able to follow steps in a repair manual, suggesting that his working memory was not a problem. On examination, the Veteran did not show cognitive impairment and, from his description of forgetting to put mail in mailboxes and passing the box, was likely distracted. This was viewed as a symptom of his mood disorder, not an additional problem. The Veteran's speech was logical, with no hallucinations, delusions, or formal thought disorder. There were no obsessions or compulsions elicited and the Veteran was oriented with adequate memory and concentration. The VA examiner commented that the Veteran had approximately the same level of impairment directly ascribable to mood problems associated with service-connected medical problems and pain as when last examined. The Veteran had signs and symtoms of a mood disorder that were transient or mild and that would decrease work efficiency and his ability to perform occupational tasks only during periods of significant stress. He appeared to manage his currently more than full time job and show some social connectedness. According to the VA examiner, if the Veteran was required to work in a situation in which there was overly close supervision, it was likely he would have more difficulty with reactivity to minor frustrations. A GAF score of 62 was assigned. A December 2011 VA annual primary care record indicates that the Veteran said he was not under stress and his mood was good. During his July 2012 Board hearing, the Veteran testified that he experienced anxiety attacks about twice a month, sleep difficulty, and infrequent episodes of irritability. See Board hearing transcript at pages 2-3. He was happily married to his wife since 1978, but was a lot more short-tempered with her than he used to be and rarely socialized with others. Id. at 4. The Veteran missed about four days of work in the past year due to headaches and his mood disorder. Id. at 5. He had memory lapses two or three times a month. Id. at 6. In January 2013, the Veteran underwent VA examination. He continued to live in his home in Iowa with his wife and had a vacation home in Arizona that he used for several weeks in the spring and fall. The Veteran went out to dinner with his wife several times a month, and attended her nephew's school ball games. He reported some mild discomfort in going to the games as well as in other social situations such as shopping. He had a history of marital tension but indicated that his marital relationship had improved somewhat. He denied any domestic abuse. The Veteran enjoyed riding his motorcycle and planned to purchase a new one in the next month. He occasionally rode with others on organized rides. The Veteran reported feeling exhausted from work at night and stayed home most evenings with his wife. He was able to complete all his activities of daily living on an independent level. The Veteran still worked with the United States Post Office, sorting and delivering mail. He planned to work three more years and retire with ten years of service. He had 28 hours of sick leave from work in the past year with no missed time due to his mood disorder. The Veteran denied any difficulties at work with tardiness, inappropriate behaviors, or poor performance. He had a difference of opinion with a coworker but did not directly raise an issue with the individual in an angry manner and reported that he learned to "walk away" from potential confrontations. The Veteran sometimes lost focus at work, such as passing by some houses for mail delivery, having to back track, and then return to deliver mail to that home. He frequently worked overtime. Further, the Veteran denied receiving any mental health services since his July 2010 VA examination. He denied taking any currently prescribed psychotropic medication or over-the-counter sleep aids. The Veteran also denied having any depression symtoms when completing a depression screen in the VA outpatient clinic in September 2010 and November 2011. According to the examination report, the Veteran's current symtoms included a depressed mood, anxiety, chronic sleep impairment. The Veteran said that, since the Gulf War, he would got anxious around crowds, such as at basketball games. The Veteran worried more than most people and got anxious about twice a month. He reported feeling sweating, chills, and numbness in his hands when anxious. He felt he startled more to the sound of thunder. The Veteran denied phobias or avoidant behaviors and reported increased irritability. His depressed mood was occasionally reactive to his physical problems. The Veteran woke several times a night, sometimes due to pain, and had nightmares a couple of times a month. He had feelings of worthlessness or guilt on sometimes related to physical functioning. The Veteran denied diminished concentration or suicidal or homicidal ideation. He had some crying spells in situations evoking patriotic feelings. There were no manic symtoms or episodes and no obsessive or ritualistic behavior. On examination, the Veteran was neatly groomed and appropriately dressed. He was alert and fully oriented, cooperative toward the examiner and displayed an appropriate affect. His attention was not disturbed and he was able to recall all three items after a one minute delay and to recall remote and recent events during the interview. There were no hallucinations, delusions, or signs of thought disorder. The Veteran reported sometimes mishearing sounds that he thought were the doorbell or a person talking to him. The diagnosis was a mood disorder due to medical condition and a GAF score of 63 was assigned, commensurate with occupational and social impairment due to mild or transient symtoms that decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symtoms controlled by medication. The VA examiner found no indications that the Veteran was malingering or of symptom exaggeration. Analysis Although the Veteran has generally been assigned GAF's indicative of minor impairment, examiners have noted the Veteran's tendency to minimize his symptoms and he has been noted to have occasional decreases in work efficiency. On at least one occasion the Veteran was noted to have complaints of minor memory problems and received a GAF of 58, indicative of moderate impairment. The March 2008, July 2010, and January 2013 VA examination reports reflect symptoms consistent with a 30 percent evaluation including some sleep disturbance, irritability, depressed mood, and anxiety. In his oral and written statements, the Veteran reported having anxiety attacks, sleep difficulty, forgetfulness, and episodes of short temper (irritability). In view of the foregoing, the Board concludes that the evidence is at least in relative equipoise as to whether it is reasonable to conclude that the disability picture is comparable to a 30 percent evaluation. Overall, the evidence shows that there is a question as to which of the two evaluations should apply, 10 percent or 30 percent, since the current level of disability arguably, but not clearly, approximates the criteria for a 30 percent evaluation. Thus, with resolution of reasonable doubt in the appellant's favor, a 30 percent rating under Diagnostic Code 9435 is warranted, under the regulations currently in effect. 38 C.F.R. § 4.7. A veteran may only qualify for a given disability rating for a mental disorder by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); 38 C.F.R. §§ 4.126, 4.130. The Veteran has reported having anxiety attacks, and flattened affect, which are examples of symptoms warranting a 50 percent rating; but he has not been shown to have most of the symptoms listed as examples in the criteria for a 50 percent rating. Significantly, the record shows that he has been able to maintain effective social and occupational relationships. He has succeeded in his employment and in maintaining relationships with his wife, other relatives, friends and his church; and mental health professionals have found the disability to be in the mild to moderate range with findings of mild disability predominating. In sum, the Veteran's symptoms do not have symptoms that equate to those needed for a 50 percent rating. Accordingly, resolving the benefit of the doubt in the Veteran's favor, the Board concludes that an initial 30 percent rating, but no higher, is warranted for his service-connected mood disorder since November 20, 2007. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, supra. D. Right Long and Little Fingers The June 2004 rating decision granted service connection for status post repair of the right long and little fingers and assigned an initial noncompensable disability evaluation under DC 5299-5230, effective June 17, 2004. The February 2013 rating decision assigned a 10 percent rating for status post repair of the right long finger under DC 5229, effective January 23, 2013, and continued the noncompensable rating for the Veteran's right little finger under DC 5230. He seeks increased initial ratings for his right long and little finger disabilities. For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The court has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. Mitchell v. Shinseki, 25 Vet App 32 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59 (2012). VA's policy is treated actually painful, unstable, or malaligned joints as warranting at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. This regulation applies to any service connected joint disability, not just arthritis. When § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis contexts, VA should address its applicability. Burton v. Shinseki, 25 Vet. App. 1 (2011). The "pain must affect some aspect of 'the normal working movements of the body' such as 'excursion, strength, speed, coordination, and endurance,'" as defined in 38 C.F.R. § 4.40, before a higher rating may be assigned. This is because "pain alone does not constitute a functional loss under the VA regulations that evaluate disability based upon range-of-motion loss." Mitchell v. Shinseki, 25 Vet. App. at 33, 43. Under Diagnostic Code 5010, traumatic arthritis is rated as degenerative arthritis under 38 C.F.R. § 4.71a, Diagnostic Code 5003. 38 C.F.R. § 4.71a, Diagnostic Code 5003, 5010 (2012). Degenerative arthritis is rated on the basis of limitation of motion under the appropriate diagnostic code for the joint involved, with a 10 percent evaluation assigned for limited motion that is noncompensable under the appropriate diagnostic code. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion, but in the absence of limitation of motion a compensable rating for degenerative arthritis can be assigned when there is X-ray evidence of the involvement of 2 or more major joints or 2 or more minor joint groups (10 percent), or X-ray evidence of the same with occasional incapacitating exacerbations (20 percent). Id. Pursuant to 38 C.F.R. § 4.71a, a maximum disability rating of 10 percent may be assigned under Diagnostic Code 5223 for favorable ankylosis of the long and ring finger of one hand. 38 C.F.R. § 4.71a, Diagnostic Code 5223 (2012). A higher disability rating of 20 may be assigned under Diagnostic Code 5219 for unfavorable ankylosis of the long and ring fingers of one hand. 38 C.F.R. § 4.71a, Diagnostic Code 5219 (2012). Under 38 C.F.R. § 4.71a, Diagnostic Code 5227, favorable or unfavorable ankylosis of the right ring or little (major) finger is rated as noncompensable. Extremely unfavorable ankylosis of the right ring or little finger may be rated as an amputation and rated under Diagnostic Code 5156. See 38 C.F.R. § 4.71a, Diagnostic Code 5227 (2012). Under the provisions of Diagnostic Code 5156, a 10 percent rating will be assigned for amputation of the ring or fifth finger without metacarpal resection, at the proximal interphalangeal joint or proximal thereto. A regulatory note following Diagnostic Code 5215 states that extremely unfavorable ankylosis of a finger exists if all the joints of the finger are ankylosed in extension or in extreme flexion, or if there is rotation and angulation of bones. 38 C.F.R. § 4.71a, Diagnostic Code 5215, Note (a) (2012). 38 C.F.R. § 4.71a, Diagnostic Codes 5156, 5215 (2012). Under Diagnostic Code 5229, limitation of motion of the index or long finger is rated noncompensable with a gap of less than one inch between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, and; extension is limited by no more than 30 degrees. 38 C.F.R. § 4.71a, DC 5229. A 10 percent rating is assigned with a gap of one inch or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. Id. That is the maximum schedular rating available for limitation of motion of the long finger. Diagnostic Code 5230 concerns limitation of motion of the ring or little finger. Any limitation of motion merits a noncompensable evaluation thereunder. 38 C.F.R. § 4.71a, Diagnostic Code 5230. Zero degrees of flexion for the index, long, ring, and little fingers represents the fingers fully extended, making a straight line with the rest of the hand. Full range of motion for the index, long, ring, and little fingers is metacarpal phalangeal joint (MCP) flexion from 0 to 90 degrees, proximal interphalangeal joint (PIP) flexion from 0 to 100 degrees, and distal interphalangeal joint (DIP) flexion from 0 to 70 or 80 degrees. 38 C.F.R. § 4.71a, Evaluation of Ankylosis or Limitation of Motion of Single or Multiple Digits of the Hand, Note (1) (2012). Facts The December 2004 VA general medical examination report reflects the Veteran's history of having a right little finger joint dislocation in 1992 in service. It was promptly reduced with residual numbness of the ulnar side of that digit that slowly resolved and was currently asymptomatic. Results of an electromyography (EMG) performed in December 1992 for the right ulnar nerve showed normal sensory function at the level of the elbow, wrist and little finger. In 1994, repair of the Veteran's right long finger dorsal extensor tendon partial laceration was performed. Both fingers were currently asymptomatic with no other right hand complaint. The Veteran was right hand dominant. His grip strength was firm, strong, and symmetric. Finger abduction and adduction strength was 5/5 (normal), fist was full and tight, and open was full, bilaterally. Opposite thumb to palm was "+/+" (normal) as were opposite thumb to tip of the long and little fingers, bilaterally. Long and little finger tips to palm were normal, bilaterally. Range of motion of the Veteran's digits was normal in both hands without pain and there was no palpable area of tenderness or pain with motion. Sensation to light touch, pinprick, and vibration, were all normal, bilaterally. An x-ray performed in December 2004 showed no acute abnormality of either hand. The March 2008 VA examiner noted that there was no pain in the Veteran's fingers. VA medical records dated in January 2009 indicate that the Veteran was seen in the emergency room with complaints of right middle knuckle pain and deformity for two weeks. He reported that he slipped on the ice while delivering mail and had constant right hand pain, particularly while working. On examination, his grip was 5/5 (normal) and there was tenderness over the third metacarpal head. The Veteran was neurovascularly intact and X-rays taken at the time were negative. The February 27, 2009 VA outpatient record includes the Veteran's complaint that the knuckle on his right hand was swollen and sore since the previous month. He was seen in the emergency room and told that there was nothing wrong and the swelling would go away. X-rays of the Veteran's hands taken by VA in March 2010 were normal. The July 2010 VA examination report includes the Veteran's complaint of some hyper mobility of his right little finger with lateral movement of the finger at the MCP joint. He had a sensation of weakness of his longer finger but was able to control it. The Veteran indicated that his fingers did not impact his daily activities but, occasionally, he caught his little finger and sprained it. On examination of the Veteran's right hand, his fingers were able to function as an integral unit for grasping. He could fully oppose the thumb to the palmar surface at the base of the little finger. The Veteran was able to oppose the thumb to the tip of each finger. His grip strength was firm and symmetric without fatiguing, lack of endurance, or incoordination. There was a slight ulnar deviation of the little finger bilaterally at the MCP joint. The VA examiner reported that the Veteran's right little and long fingers, with residual scar on the dorsum of the right long finger, were without demonstrable impact on functional ability. During his July 2012 Board hearing, the Veteran said his right little finger stuck out and occasionally caught on things and went numb. See Board hearing transcript at page 18. His two fingers tingled and his hand went numb that affected his ability to deliver mail daily. Id. The Veteran was able to move his finger but when it caught on something, it was sprained and he taped it to his other finger that was annoying. Id. at 19. He had problems with his finger about twice a month but was able to move his fingers during these episodes although it was painful. Id. at 20. A January 2013 VA hand examination report indicates that the Veteran complained that his right long finger throbbed and burned daily and that was worse in cold weather. His middle joint was enlarged, and he had weakness, decreased grip, and difficulty turning any knob like a faucet or drain. The Veteran was able to bend his little finger but it was weak and stuck out. The Veteran felt his right hand strength was about 70 percent of his left hand strength. He had constant pain that slowed him down in his job sorting mail and required that he use more time to sort mail that left him the last one out of the post office. His grip was not as strong. He had flare ups of joint disease for which he took prescribed medication for arthritis. The Veteran reported that flare ups impacted his right hand function and said his pain was worse with cold weather. He worked outdoors half the day delivering mail. On physical examination, range of motion of the Veteran's right hand was finger flexion, 1 inch or more gap finger-to-palm with painful motion of the long and little fingers, and no gap thumb-to-fingers. There was no limitation of extension noted. The Veteran's right little finger could be extended, but at an angle of 40 degrees from the ring finger. He was not able to actively close his fingers together but could passively move his little finger next to the ring finger. His little finger stuck out to the side. After three repetitions, there was a finger-to-palm gap of 1 inch or more and thumb-to-fingers of 1-2 inches, but no additional limitation of range of motion in any of the fingers following repetitive use testing. The Veteran had functional loss or impairment of his fingers with less movement than normal in his right long, ring and little fingers. The Veteran's right middle (long) finger showed limitation of motion, painful motion, incoordination, swelling, and deformity. His right little finger showed painful motion and incoordination. There was no finding of ankylosis reported. There was pain on palpation of the right hand. Grip strength was 3/5 on the right and 5/5 on the left (normal). The Veteran had three small scars on the dorsal surface of the right long finger and small round discoloration that were not painful, unstable or greater than 39 square centimeters (cm) in total area. As to the functional impact of right finger disabilities, the VA examiner commented that the Veteran had limited grip in his right hand, and used his index finger and thumb to sort mail. It took him longer to do tasks than his co-workers. The Veteran was the last one to finish the day and usually had help from others during inclement weather. His pain increased during cold weather conditions. The Veteran's job was indoors in the morning sorting mail and delivery on a city mail route in the afternoon. The VA examiner reported additional functional impairment due to pain, pain on repeated use, weakness, and incoordination of the right long finger. As to the right little finger, there was functional impairment with limited motion, weakness, and incoordination. Analysis 1. Right Long Finger The December 2004 VA examiner reported normal range of motion of the digits of both hands, without pain, and the March 2008 examiner similarly noted no pain in the fingers. The July 2010 VA examiner reported that the Veteran could fully oppose the thumb to the tip of each finger and had a firm and symmetric grip strength, without evidence of fatiguing, lack of endurance, or incoordination. The examiner found the right long finger disability, with residual scar on the dorsum, was without demonstrable impact on functional ability. This evidence weighs against a finding that an initial compensable rating for the Veteran's right long finger disability was warranted prior to January 23, 2013. There is no evidence showing limited right long finger motion prior to January 23, 2013,evidenced by a gap of one inch or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. The preponderance of the evidence is against an initial compensable rating for status post right long finger repair prior to January 23, 2013. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.71a, DC 5529. Further, from January 23, 2013, the Veteran is in receipt of a 10 percent rating for his right longer finger disability that is the maximum schedular evaluation available for limitation of motion of the long finger under DC 5229. At no time since the Veteran filed his initial service connection claim has the evidence demonstrated unfavorable ankylosis of the long finger such as to warrant a higher disability rating of 20 percent under Diagnostic Code 5219. 38 C.F.R. § 4.71a, Diagnostic Code 5219 (2012). Ankylosis, whether favorable or unfavorable, involves fixation of the finger joint. Ankylosis is the immobility and consolidation of a joint due to disease, injury, or surgical procedure. Lewis v. Derwinski, 3 Vet. App. 259 (1992). The Veteran also has three small scars on the dorsal surface of his right long finger, that are not painful, unstable, or greater than 39 square cm in total area. See January 2013 VA examination report. Thus, a separate compensable rating for the scars is not warranted. 38 C.F.R. § 4.118, Diagnostic Code 7801, 7804, 7805 (2008) and (2012), as in effect prior to and after October 23, 2008. Thus, the preponderance of the evidence is against a compensable rating prior to January 23, 2013, and a rating in excess of 10 percent from January 23, 2013 for the Veteran's service-connected status post repair of the right long finger. Moreover, as the preponderance of the probative medical and other evidence of record is against the claim for an increased (compensable) initial rating prior to January 23, 2013, and a rating above 10 percent for status post repair of the right long finger from January 23, 2013, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C.A. § 5107(b). 2. Right Little Finger. The evidence shows that the December 2004 and March 2008 VA examination reports do not reflect any pain or limited motion or ankylosis associated with the Veteran's right little finger. The July 2010 VA examiner noted the Veteran's complaint of some hyper mobility of his right little finger but found no evidence of limited motion or ankylosis associated with the Veteran's right little finger. The January 2013 examiner noted painful motion, weakness, and incoordination but no evidence of ankylosis or any findings commensurate with amputation such as to warrant a compensable rating. 38 C.F.R. § 4.71a, DCs 5156, 5227, 5230. The preponderance of the objective and credible evidence is against the Veteran's claim for a compensable rating for status post repair of his right little finger. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.71a, DCs 5156, 5227, 5230. Moreover, the evidence is not so evenly balanced as to allow for the application of reasonable doubt. 38 U.S.C.A. § 5107(b). See generally Gilbert; Ortiz, supra Other Finger Ratings Except as otherwise provided in the rating schedule, all disabilities, including those arising from a single entity, are to be rated separately. See 38 C.F.R. § 4.25 (2012); see also Esteban v. Brown, 6 Vet. App. 259, 261 (1994). However, the anti-pyramiding provision, 38 C.F.R. § 4.14 (2012), states that evaluation of the 'same disability' or the 'same manifestation' under various diagnoses is to be avoided. Evaluation of the same disability under various diagnoses is to be avoided. See Fanning v. Brown, 4 Vet. App. 225 (1993). Here, the evidence shows that results of the Veteran's 1992 EMG were normal, indicating no neurological impairment associated with his right little finger injury at that time. The December 2004 VA examiner reported that sensation to light touch, pinprick, and vibration were all normal in the Veteran's hands. However, the Veteran recently testified that his right little finger stuck out and occasionally caught on things and went numb. He said that his two fingers tingled and his hand went numb and this affected his ability to deliver mail. The January 2013 VA examiner reported that the Veteran experienced diminished grip strength on the right with functional impairment due to pain, pain on repeated use, weakness, and incoordination of the right long finger, and limited motion, weakness, and incoordination of his right little finger. Under Diagnostic Code 8516, complete paralysis of the ulnar nerve of the major upper extremity, that warrants a 60 percent evaluation, includes the "griffin claw" deformity, due to flexor contraction of ring and little fingers, atrophy very marked in dorsal interspace and thenar and hypothenar eminences; loss of extension of ring and little fingers cannot spread the fingers (or reverse), cannot adduct the thumb; and flexion of wrist weakened. 38 C.F.R. § 4.124a, Diagnostic Code 8516. For incomplete paralysis, a 10 percent rating is assigned for a mild disability, a 30 percent rating is assigned for a moderate disability afflicting the dominant hand, and a 40 percent rating is assigned for a severe disability afflicting the dominant hand. Id. While no VA examiner has expressly stated that the Veteran experiences ulnar nerve damage in his right hand, he has provided credible testimony regarding his right hand and finger numbness and weakness. The January 2013 VA examiner reported the Veteran's decreased grip strength and right little finger painful motion, weakness, and incoordination. These are symptoms contemplated in the criteria for rating ulnar nerve impairment. Id. Thus, the evidence is in equipoise as to whether the Veteran's right little finger symptomatology is commensurate with mild incomplete paralysis of the right ulnar nerve and warrants a separate compensable rating. Affording the Veteran all benefit of the doubt, the Board finds that a separate 10 percent rating, but no higher, is warranted for mild ulnar disablement of the right little finger since June 17, 2004. However, there is simply no evidence of any findings remotely commensurate with moderate incomplete paralysis of the right ulnar nerve such as to warrant a higher 30 percent rating under DC 8516. The benefit of the doubt has been resolved in the Veteran's favor to this limited extent. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, supra. Both Fingers With regard to establishing loss of function due to pain, it is necessary that complaints be supported by adequate pathology and be evidenced by the visible behavior of the claimant. 38 C.F.R. § 4.40. The effects of pain reasonably shown to be due to the Veteran's service-connected right finger disabilities are contemplated in the currently assigned noncompensable evaluation prior to January 23, 2013 and 10 percent rating for the right long finger disability, and separate 10 percent rating for the right little finger disability, granted herein. Even with consideration of the VA examiner's report of pain, limited grip, and incoordination affecting the Veteran's daily activities, there is no indication that pain, due to disability of the right long and little fingers, caused functional loss greater than that contemplated by the currently assigned evaluations. 38 C.F.R. §§ 4.40, 4.45 DeLuca. A separate evaluation for pain is not for assignment. Spurgeon Extra-schedular Rating The Board has also considered whether the Veteran's otitis media, chronic rhinitis, mood, and right finger disabilities present an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards such that referral to the appropriate officials for consideration of an extra-schedular rating is warranted. See 38 C.F.R. § 3.321(b)(1) (2012); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996). Pursuant to § 3.321(b)(1), the Under Secretary for Benefits or the Director, Compensation and Pension Service, is authorized to approve an extraschedular evaluation if the case "presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards." 38 C.F.R. § 3.321(b)(1) (2012). The question of an extraschedular rating is a component of a claim for an increased rating. See Bagwell v. Brown, 9 Vet. App. 337, 339 (1996). Although the Board may not assign an extraschedular rating in the first instance, it must specifically adjudicate whether to refer a case for extraschedular evaluation when the issue either is raised by the claimant or is reasonably raised by the evidence of record. Barringer v. Peake, 22 Vet. App. 242 (2008). When it is not possible to separate the effects of a non-service-connected condition from those of a service-connected disorder, reasonable doubt should be resolved in the claimant's favor with regard to the question of whether certain signs and symptoms can be attributed to the service- connected disability. See Mittleider v. West, 11 Vet. App. at 182. Here the Board has considered Mittleider and attributed all potentially service-connected symtoms to his service-connected otitis media, chronic rhinitis, mood, and right finger disabilities before considering if the Veteran is entitled to an extra-schedular rating. If the evidence raises the question of entitlement to an extraschedular rating, the threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Therefore, initially, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. Thun v. Peake, 22 Vet. App. 111 (2008). Under the approach prescribed by VA, if the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. In the second step of the inquiry, however, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." 38 C.F.R. 3.321(b)(1) (related factors include "marked interference with employment" and "frequent periods of hospitalization"). The evidence does not show marked interference with employment or frequent hospitalization as a result of the Veteran's otitis media, chronic rhinitis, mood, and right finger disabilities that would warrant consideration of referral for an extraschedular rating. The manifestations of the Veteran's disabilities include hearing loss, nasal stuffiness, mood impairment, and painful finger motion, weakness, and incoordination. The rating schedule contemplates these symptoms. Diagnostic Codes 6201, 6522, 5229-5230, and 9435. The rating schedule is meant to compensate for average impairment in earning capacity and for considerable time lost from work commensurate with the percentage evaluations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Thus, the Board finds that the threshold test is not met for referral for extraschedular consideration. Id.; see also Thun v. Peake, 22 Vet. App. at 111. In addition, the Veteran has reported headaches as part of his rhinitis. Service connection is in effect for migraines; however, and the record shows that all headaches regardless of etiology have been considered in providing that rating. Because there are no manifestations of the Veteran's disabilities that are outside the rating criteria, referral for extra-schedular rating is not warranted. TDIU Board notes that if the claimant or the record reasonably raises the question of whether the Veteran is unemployable due to the disability for which an increased rating is sought, then part and parcel to that claim for a higher rating is whether a total rating based on individual unemployability (TDIU) as a result of that disability is warranted. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Here, the record reveals that the Veteran repeatedly told VA examiners, most recently in 2013, that he worked as a mail carrier for the postal service. Thus, any further consideration of the Veteran's claim under Rice is not warranted at this time. ORDER An initial compensable evaluation for bilateral otitis media is denied. From June 17, 2004 to December 9, 2007, an initial compensable evaluation for chronic allergic perennial rhinitis is denied. From December 10, 2007 to February 26, 2009, a 30 percent evaluation for chronic allergic perennial rhinitis is granted, subject to the laws and regulations governing the award of monetary benefits. From February 27, 2009 to January 22, 2013, a compensable evaluation for chronic allergic perennial rhinitis is denied. From January 23, 2013, rating in excess of 10 percent for chronic allergic perennial rhinitis is denied. A 30 percent rating is granted for a mood disorder from November 20, 2007, subject to the laws and regulations governing the award of monetary benefits. An initial compensable evaluation for status post repair of the right long finger prior to January 23, 2013, and a rating higher than 10 percent thereafter, is denied. An initial compensable evaluation for status post repair of the right little finger is denied. A separate 10 percent rating, but no higher, is granted for right ulnar disablement of the right little finger since June 17, 2004, subject to the laws and regulations governing the award of monetary benefits. ____________________________________________ Mark D. Hindin Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs